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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 1--3 -'1 <br /> Site: Beacon #695 Pro]ect No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- _/Y. _ <br /> Lodi, CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO ES If no, see remarks <br /> Height of well casing riser (in inches) : L4 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP _X 12" CNI 36" CNI ther <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: _2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer Teflon bailer: <br /> Well Diameter: 2"4- 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br />• Initial Measurement Recharge Measurement <br /> Time: !1 Time: ^ l Calculated purge: <br /> Depth of well: n' :I, Depth to water: Actual purge: <br /> Depth to water: Ki <br /> Start purge: �fSampling time: 4 Z <br /> Time Temp. E.C. pH Turbidity Volume <br /> � � 3 <br /> Sample appearance: , - Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />